How Mental Health Referrals Help Physicians Give Better Care

According to a recent health story from National Public Radio, depression is the catalyst for more than 8 million doctors’ appointments each year. More than half of those appointments are with primary care physicians, which highlights the important role primary care physicians have in the screening, diagnosis, and treatment of depression and other common mental health conditions.

Despite the high number of individuals trying to access some level of mental health treatment through their primary care physicians’ offices, a 2013 brief by the Centers for Medicare and Medicaid Services (CMS) estimates 80% of adults experiencing mental health issues never see or are referred to a mental health specialist for treatment. In fact, CMS suggests that only 25% of people with depression or other common mental health issues ever receive effective care.

To address the significant gap that exists between mental and physical health treatments in primary care settings, CMS has pushed for states to adopt a collaborative care model that integrates primary care with case managers and mental health specialists. This approach mirrors the treatment guidelines from the American Psychiatric Association, which advocates for treating major depression, from mild to severe cases with psychotic features, with a combination of pharmacotherapy and psychotherapy.

As a leading online directory of psychotherapists, psychiatrists, and mental health specialists that has helped connect millions of people with a mental health professionals since 2007, GoodTherapy.org recognizes the importance of collaborative care. Below, we outline three powerful reasons for physicians to refer to or collaborate with mental health specialists:

Mental Health Referrals and Collaborative Care Help Provide Better Treatment for Your Patients

The Centers for Medicare and Medicaid Services estimate that as few as 20% of people who started an antidepressant medication in primary care will show “substantial clinical improvement.” Additionally, CMS states that we know when mental and behavioral health concerns are left untreated, the following occurs:

• A person’s ability to maintain self-care becomes impaired
• Adherence to treatment plans are negatively affected
• Mortality rates increase
• The person’s work productivity can decrease
• Health care costs increase

Despite the high level at which patients enter primary care for depression and other common mental health issues, a recent study published in the journal Health Affairs suggests that primary care practices may not be well equipped to manage depression as a chronic illness. Simply put, reaching out to a mental health professional for collaborative care may allow you to provide better mental and physical health outcomes overall for your patients.

Available Evidence Supports the Efficacy of Collaborative Care for Mental Health Issues

The collaborative care approach has been studied extensively across various primary care settings and populations. In its brief on collaborative care, CMS points to more than 70 randomized controlled trials as its body of evidence for The gaps in mental health treatment exacerbate poor physical health for many and causes some to live with treatable mental health issues, often as a result of stigma. Pursuing better approaches to treating mental health and wellness creates a world of stronger, healthier communities, which benefits us all.the treatment model. The agency found that collaborative health care teams consisting of a primary care provider, support care management staff (such as a psychologist or clinical social worker), and a psychiatric consultant were both more effective at delivering better health care outcomes and more cost-effective overall, regardless of practice size or population being treated. Additionally, several studies highlighted by CMS indicate a collaborative approach to health care may be especially effective at reducing health disparities in ethnic minority groups and low-income populations.

The IMPACT Trial, a program of the University of Washington Department of Psychiatry and Behavioral Sciences, is one of the largest research projects to have studied depression care. The study followed the outcomes of more than 1,800 adults experiencing depression from more than 18 different primary care facilities over a 2-year period.

According to the findings of the IMPACT Trial, published in 2002 in the Journal of the American Medical Association, people experiencing depression who received collaborative care reported a 50% reduction in symptoms, compared to about 19% who received care from a physician only. Additionally, follow-up research after the conclusion of the IMPACT Trial revealed that patients who received collaborative care experienced more than 100 additional days free of depression symptoms over a 2-year period when compared to those treated solely by a primary care physician.

Reaching Out to Mental Health Partners Makes Physical and Mental Health Care More Cost-Effective

Referring a patient to a mental health specialist or integrating mental health care as part of a collaborative care approach makes financial sense too. The Centers for Medicaid and Medicare Services estimate that health care costs can increase by 50-100% if a patient is experiencing depression. Additionally, patients experiencing major depression and a chronic medical condition, on average, have more than twice the health care costs when compared to people who aren’t experiencing depression.

Another important part of the University of Washington’s IMPACT Trial was examining long-term health care costs over a 4-year period. At the end of the study, researchers discovered an initial investment in collaborative care resulted in significant savings over time. The published results indicate that every dollar spent on collaborative care saves $6.50 in health care costs. Primary care practices that used a collaborative care approach for depression treatment during the study saved an average of nearly $850 per year for each patient. The average net cost savings over a 4-year period for people with depression were about $3,400 per patient.

How We Can Help

Part of our mission at GoodTherapy.org is to challenge mental health stigma and educate the public about mental health conditions and treatment. The gaps in mental health treatment exacerbate poor physical health for many and causes some to live with treatable mental health issues, often as a result of stigma. Pursuing better approaches to treating mental health and wellness creates a world of stronger, healthier communities, which benefits us all.

Our organization is ranked as one of the top directories of mental health professionals, therapists, and psychiatrists on the internet, with thousands of members in more than 30 countries worldwide. Visitors to GoodTherapy.org can search for a mental health specialist or therapist by location, specialty, treatment modality, or several other factors. We ensure the highest membership standards of any online mental health directory and verify that each member meets strict educational, licensure, and philosophical guidelines.

Whether you’re searching for a mental health referral or a partner to assist your practice in a collaborative care approach, GoodTherapy.org can help you provide better, more cost-effective treatment for people experiencing mental health challenges.

References:

1. Bishop, T. F., Ramsay, P. P., Casalino, L. P., Bao, B., Pincus, H. A., & Shortell, S. M. (2016 March). Care management processes used less often for depression than for other chronic conditions in US primary care practices. Health Affairs, 35(3). 394-400. doi: 1377/hlthaff.2015.1068
2. Luthra, S. (2016, March 7). Doctors often fail to treat depression like a chronic illness. NPR. Retrieved from http://www.npr.org/sections/health-shots/2016/03/07/469504900/doctors-often-fail-to-treat-depression-like-a-chronic-illness
3. Overview of the IMPACT trial. (n.d.) University of Washington, Department of Psychiatry and Behavioral Sciences. Retrieved from http://impact-uw.org/about/
4. Treating major depressive disorder: a quick reference guide. (n.d.) American Psychiatric Association. Retrieved from http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd-guide.pdf
5. Unützer, J., Harbin, H., Shoenbaum, M., & Druss, B. (2013 May). The collaborative care model: an approach for integrating physical and mental health care in medicaid health homes. Health Home. Retrieved from https://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRC-Collaborative-5-13.pdf

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